7th Anniversary of Cerebral Infarction: 'Still Continuing to Recover' Part III - Post-Discharge Rehabilitation and Self-Training (Middle Part)

Part III: Post-Discharge Rehabilitation and Self-Training (Middle Part)

This article is a sequel to the following article.

13. Difficulties in Daily Life After Discharge

After being discharged and returning home to resume daily life,
there was a deterioration in my health due to the cerebral infarction,
and I faced various difficulties with daily activities.

Buttoning long-sleeved shirts

This was truly difficult.
Even though my left hand had started to move to some extent,
fine motor skills in my fingers were still impossible.

Because of this, I bought an assistive device for buttoning long sleeves,
but I don't need it now because I recovered enough to button them myself.

Constipation

As I wrote before,
this was the most painful aftereffect.
The period up to about one year after discharge
was the hardest.

It has improved rapidly over the past two years,
and now I have a bowel movement every day or every other day.
Since I haven't changed my diet or other habits significantly,
I attribute this to the recovery of my autonomic nervous system.

I tried various laxatives.
For the first few years after discharge, I was prescribed magnesium oxide,
but it wasn't very effective and I stopped due to a tendency toward hypermagnesemia.

I am currently prescribed Goofice, which feels relatively good. I am also
increasingly able to stop taking it depending on my physical condition.
I decided that stimulant laxatives should be avoided for long-term use,

so I do not use them.
I also tried various foods, but

I still consciously try to consume foods rich in dietary fiber (soluble and insoluble).

In addition, I take indigestible dextrin as a supplement.
This is also a measure for blood sugar control.

Unable to use chopsticks

Immediately after the onset, far from using chopsticks,
my entire left side was paralyzed, with no movement from my left shoulder down to my arm and fingers,
but by the time I was discharged from Kanagawa Rehabilitation Hospital,

I had managed to become able to use a spoon.

However, even though I could hold chopsticks,
the two chopsticks would cross and I couldn't use them at all.

I didn't get used to and didn't use chopsticks with hinges or spring-loaded assistive devices.

About two years later, I was able to use them practically,
and although I am still clumsy,
I have gradually become able to use chopsticks with more dexterity,
and it still feels like I am improving day by day.

14. Post-Discharge Rehabilitation Practice

My policy is 24/7 rehabilitation, but
I follow the schedule below.

Weekly Schedule

Outpatient rehabilitation 3 times a week (Kariba Neurosurgery Hospital)
OT: Repetitive Facilitative Exercise (Kawahira Method)
PT: Standard rehabilitation training

Daily Schedule

Roughly speaking, my life consists of
self-training in the morning,
outpatient rehabilitation in the afternoon (when scheduled),
and work or other activities during the remaining time.

15. Repetitive Facilitative Exercise (Kawahira Method)

To start with the conclusion,
during the period I practiced Repetitive Facilitative Exercise (Kawahira Method),
I achieved the following remarkable recovery.

1. I became able to use chopsticks

2. I became able to play a musical instrument (saxophone) again

However, as I mentioned before,
objective scientific verification is not possible.

There are the following four possibilities
for the cause of my progress in recovery.

1. The effects of Repetitive Facilitative Exercise (Kawahira Method)

2. Natural healing

3. Placebo effect

4. A combination of the above effects

Unfortunately, I cannot say for sure, but the results are all that matter.

Practicing Repetitive Facilitative Exercise (Kawahira Method) at Kariba Neurosurgery Hospital

I had been interested in Repetitive Facilitative Exercise since I was hospitalized at Kanagawa Rehabilitation Hospital,
and I even ordered Dr. Kawahira's books while I was there
and read them.
As I wrote in the first part, the Kawahira Method is listed as

Grade B (recommended) in the Stroke Guidelines 2015,
and I found the theoretical basis convincing.
When I was hospitalized at Kanagawa Rehabilitation Hospital,
I asked the physical therapists and occupational therapists,

'What do you think of the Kawahira Method?'
and they all knew about it.

One occupational therapist said,
'I bought the DVD too.
I think it's quite good.
I incorporate it into my own practice.'

This person was very studious, and their OT sessions were precise and theoretical,
so I had a very good impression of them.

There are significant differences in thinking among medical universities, research institutions, and doctors.
Some doctors have called the 'Kawabira Method' a 'classical technique,'
but I suspect it was said with a mocking tone.

I assume they base this on the fact that 'facilitation' was developed in the 1940s,
but I believe the 'facilitation' of that time and the repetitive facilitation of the 'Kawabira Method' are different.

The rehabilitation department at Shonan Kamakura General Hospital, which took care of me during the acute phase and post-discharge rehabilitation,
had excellent rehabilitation services despite being an acute care hospital,
and many of the staff were wonderful, but unfortunately, they did not practice the Kawabira Method.

At that time, there were only two places in Kanagawa Prefecture practicing the Kawabira Method, and both were part of the IMS Group.
I first called Shintotsuka Hospital, but they said there was a wait of several months. It was very popular.

So,
when I called Kariba Neurosurgical Hospital, they said it was okay, and Shonan Kamakura Tokushukai wrote me a referral letter.

Rehabilitation began promptly at the end of November.
It was conducted 3 times a week, 1 hour and 40 minutes per session, with both OT and PT.
It was 1 hour and 40 minutes each on Mondays, Wednesdays, and Fridays.

Regarding the Kawabira Method (Repetitive Facilitation Therapy),
to express my own brief impressions and essence,
as a layman

while other treatment methods (sorry for summarizing them roughly) are

'setting appropriate goals and training according to the level of recovery,'
'(using assistance as well) repeatedly challenging oneself,'
'and making it possible to do it on one's own,'

the Kawabira Method (Repetitive Facilitation Therapy) is,
'first, by using assistance to create a successful experience of having "done it"'
'repeatedly at a high frequency (at least 100 times per part) to engrave it into the brain,'
'promoting the reconstruction of neural pathways,'
'and eventually making it possible to do it on one's own.'

Is that what it is?

When I actually tried it,
I was very surprised by the repetitive assistance.

In one hour, they did a total of over 1000 repetitions
for each part of my upper limbs.

When I said to the occupational therapist in charge,
'This must be hard for you,'

they replied with a smile,
'I'm used to it,' but

I thought,
'Wouldn't it not be worth it unless you get a "Kawabira Method allowance"?'

Usually, in rehabilitation, I was often asked, 'Aren't you tired?' but

with Repetitive Facilitation Therapy (Kawabira Method),
it felt like I had moved my body comfortably!

That was the feeling.

Effective for finger separation, in other words, effective for musical instruments

My occupational therapist explained the 'Kawabira Method' as
a method that is
particularly effective for finger isolation.
I was told.

This matched my own experience
that the 'Kawabira Method' is effective for finger isolation.

To have a functional hand,
dexterous finger movements are essential.

There are various patterns for finger facilitation repetition in the 'Kawabira Method',
but it involves performing
facilitation repetition for each finger individually, while suppressing the movement of the other fingers.

In the method I received,
although it varied slightly from day to day,
there were 3 patterns for the thumb,
2 patterns each for the index, middle, ring, and little fingers, and for the thumb and little finger combined,

and since I repeated each 100 times,
that makes a total of 1,200 facilitation repetitions just for the fingers.

I don't think just doing a high number of repetitions is everything,
but after having it done,
I felt that my isolation had clearly improved.

As I have said many times,
I cannot definitively prove the effects through objective verification,
but I felt that my finger isolation
accelerated more than before I started the 'Kawabira Method'.

In the case of playing a musical instrument,
finger isolation is particularly important.

Also, since repetitive finger movement practice is common even for healthy people practicing instruments,
in that sense as well,
I think the 'Kawabira Method' has high compatibility.

Secondary mental effects

If rehabilitation is painful,
you end up going reluctantly,
which becomes a mental burden.

In that respect, it was good that I could look forward to going to
my 'Kawabira Method' rehabilitation sessions.

I will describe the benefits from the perspective of
mental state and motivation in rehabilitation.

The reason why the 'Kawabira Method' can be continued with high motivation,
as I feel it,

is that there is no sense of defeat, but rather a sense of accomplishment.
Rehabilitation through 'facilitation repetition' always provides a sense of accomplishment.

That is also thanks to the assistance of the occupational therapist.

Rehabilitation is also a battle against plateaus,
but there is no sense of defeat or fatigue from
'no matter how much I try, I can't do it'.
I never feel exhausted from rehabilitation.

Especially when I am instructed to do training that doesn't match my readiness,
the sense of defeat and fatigue is terrible. I feel bad for the OT, but
I feel like saying a word of resentment, like
'It's easy for you because you're just giving instructions'.

In fact, a friend of mine from a cerebral infarction blog
said that because they were instructed to do training that was too difficult and didn't match their readiness,
they were so outraged that
they left in the middle of rehabilitation.

This never happens with the Kawabira Method.
Because it is 'all success'.

This is also thanks to the assistance of the occupational therapist.

After finishing Repetitive Facilitative Exercise (Kawahira Method)

Although objective effects cannot be verified,
it is an undeniable fact that
I have experienced remarkable recovery
that exceeded my expectations.

Around January 2019, I couldn't use chopsticks well because the tips would cross,
but now I can eat using my left hand 100% of the time.

As for the saxophone, it was not in a practical state when I started the Kawahira Method,
but I was able to perform a comeback at a shop in March.

I will discuss TMS therapy and
my attempt at the Muse cell clinical trial (which I was not eligible for)
next time.

Thank you very much
for reading this article to the end.
I will continue to post articles related to happiness,
so I would appreciate it if you could
like, comment, or follow.


Kimio Matsushima, Representative Director, E-Happiness Co., Ltd.*Profile*

*Notice*

16. TMS Therapy

17. Pseudo-CI Therapy

18. Muse Cell Clinical Trial Attempt

19. Driving a Car Again

20. Rehabilitation with Sax

21. Comeback Performance

Sax Performance at a Jazz Live

22. Opposing the term "Maintenance Phase (Chronic Phase)" for the period after 6 months post-onset, proposing a name change

Calling for the abolition of the term "Maintenance Phase (Chronic Phase, Living Phase)" and a change to a name that evokes continued rehabilitation and recovery effects
Reasons for proposing the abolition and renaming of the "Maintenance Phase"
"The fact of recovery" is stranger than "established theory"!

23. Post-Discharge Rehabilitation - Choice of Therapy and Recovery Effects

Part IV From the End of Rehabilitation to the Present

24. A Life of Constant Rehabilitation

Continuing self-training
Rehabilitation through hobbies (Saxophone, photography, model making)
Rehabilitation through housework
Onset of brainstem infarction

25. Current progress of recovery

26. Self-training is every day, seven days a week

27. The necessity of active communication with attending physicians, PTs, OTs, and STs

Conclusion